ARDS in pediatrics. Results of a survey in German children's hospitals and recommendations of the ''Working Group Pediatric ARDS'' on respiratory management

Acute respiratory distress syndrome (ARDS) is a therapeutic challenge in pediatric intensive care in view of its high mortality. In 1992, about 50 German pediatric intensive care unit doctors founded a working group with the aim of collaborating in clinical research. The objectives of both a prospective and retrospective survey conducted in German pediatric intensive care units in 1993 was to accumulate data on the epidemiology, risk factors and natural history in a large group of pediatric ARDS patients. 112 patients were reported, an incidence of 7 cases per 1000 admissions to pediatric intensive care units. Half of the children were less than 2 years old. In 43 % of the cases, ARDS was associated with a pulmonary, in 39 % with a underlying systemic disease. Mortality was 46 % and independent of age, sex and triggering event. The number of associated organ failures, however, strongly influenced mortality. The analysis of treatment modalities employed in the patients revealed a lack of uniform therapeutic strategies. On the other hand, the patients were exposed to interventions not yet supported by controlled trials. The data gathered in this survey provide the basis for the design of prospective multicenter studies urgently needed to evaluate innovative treatment modalities in pediatric ARDS. Recommendations on ventilatory management and patient monitoring are included for this purpose.